To the Editor: As a long-time user, advocate, and teacher of the Bullard[trade mark sign] laryngoscope (Circon Corporation, Stamford, CT), I (ETC) was surprised to read the case report by Habibi et al. [1] alleging that a blade extender could be easily dislodged by incidental contact with the patients teeth during removal of the laryngoscope from the mouth. Based on their experience, they further recommend the cautious use of the Bullard[trade mark sign] laryngoscope in patients with a limited mouth opening, a patient group for whom many have found the Bullard[trade mark sign] laryngoscope to be ideally suited. I have been very impressed over the years at the retention strength of the connection between the extender and the laryngoscope blade, provided that the extender is appropriately seated and secured. After reading Habibi et al.'s article, I decided to measure the strength of the connection. We mounted a spring scale (Hanson, Shubuta, MS) to a vise. We then measured the retention strength of the connection by determining the applied force (reflected as weight in kilograms), which was necessary to separate the extender from the blade. We used our two Bullard[trade mark sign] laryngoscopes and attached five different blade extenders, both new and previously used, to each of the laryngoscopes. Each extender blade combination was tested twice, and a mean force for disconnection was determined. The mean +/- SEM force necessary to separate the connection was 10.5 +/- 1.0 kg (23.9 +/- 2.3 lb). There was a slight difference in the force required when comparing the used extenders (9.9 +/- 0.36 kg) with the new ones (10.86 +/- 0.9 kg), but the difference did not reach significance (P = 0.58), nor is it likely to be clinically important. Our experiment validated our confidence in the extender laryngoscope connection, demonstrating that considerable force must be applied to separate the extender from the blade. We find it difficult to accept that the forces demonstrably necessary to separate an extender from the Bullard[trade mark sign] laryngoscope blade could ever be achieved during anything remotely resembling normal use. Further, it suggests that human error, rather than technical failure, contributed to both events reported by Habibi et al. Finally, we believe that the review process should have insisted on an objective forensic assessment of the incident, similar to what we conducted, to support the allegation of technical failure. Had this been done, the authors would likely have come to a different conclusion regarding the causes of the disconnection. Their published caution would have further emphasized the importance of training in the proper use of the Bullard[trade mark sign] laryngoscope, rather than the unsupported and likely invalid caveat regarding technical failure. Edward T. Crosby, MD* Mark J. Cleland, BMET[dagger] Departments of *Anesthesiology and [dagger]Biomedical Engineering; Ottawa Hospital-General Site; University of Ottawa; Ottawa, Ontario, Canada K1H 8L6
Read full abstract